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Broberg MA, Boyd BS. Similarities between explaining dizziness and explaining pain? Exploring common patient experiences, theoretical models, treatment approaches and potential therapeutic narratives for persistent dizziness or pain. Physiother Theory Pract 2023; 39:2502-2519. [PMID: 35751384 DOI: 10.1080/09593985.2022.2091497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Pain and dizziness are common experiences throughout the lifespan. However, nearly a quarter of those with acute pain or dizziness experience persistence, which is associated with disability, social isolation, psychological distress, decreased independence, and poorer quality of life. Thus, persistent pain or dizziness impacts peoples' lives in similarly negative ways. Conceptual models of pain and dizziness also have many similarities. Many of these models are more expansive than explaining mere symptoms; rather they describe pain or dizziness as holistic experiences that are influenced by biopsychosocial and contextual factors. These experiences also appear to be associated with multi-modal bodily responses related to evaluation of safety, threat detection and anticipation, as influenced by expectations, and predictions anticipation, not simply a reflection of tissue injury or pathology. Conceptual models also characterize the body as adaptable and therefore capable of recovery. These concepts may provide useful therapeutic narratives to facilitate understanding, dethreaten the experience, and provide hope for patients. In addition, therapeutic alliance, promoting an active movement-based approach, building self-efficacy, and condition-specific approaches can help optimize outcomes. In conclusion, there are significant overlaps in the patient experience, theoretical models and potential therapeutic narratives that guide care for people suffering with persistent pain or dizziness.
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Affiliation(s)
- Marc A Broberg
- Department of Physical Therapy, Two Trees Physical Therapy and Wellness, Ventura, CA, USA
| | - Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
- Physical and Sports Medicine, Stanford ValleyCare, Livermore, CA, USA
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2
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High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:59-69. [PMID: 35782163 PMCID: PMC9219347 DOI: 10.1016/j.smhs.2021.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/19/2023] Open
Abstract
Areas at high-altitude, annually attract millions of tourists, skiers, trekkers, and climbers. If not adequately prepared and not considering certain ascent rules, a considerable proportion of those people will suffer from acute mountain sickness (AMS) or even from life-threatening high-altitude cerebral (HACE) or/and pulmonary edema (HAPE). Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting. Appropriate acclimatization by slowly raising the hypoxic stimulus (e.g., slow ascent to high altitude) and/or repeated exposures to altitude or artificial, normobaric hypoxia will largely prevent those illnesses. Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases, knowledge of symptoms and signs, treatment and prevention strategies will largely contribute to the risk reduction and increased safety, success and enjoyment at high altitude. Thus, this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.
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Dünnwald T, Kienast R, Niederseer D, Burtscher M. The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude. SENSORS 2021; 21:s21041263. [PMID: 33578839 PMCID: PMC7916608 DOI: 10.3390/s21041263] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.
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Affiliation(s)
- Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT—Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | - Roland Kienast
- Department of Biomedical and Health Technology, Federal Higher Technical Institute for Education and Experimentation—HTL Anichstraße, 6020 Innsbruck, Austria;
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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Mujika I, Sharma AP, Stellingwerff T. Contemporary Periodization of Altitude Training for Elite Endurance Athletes: A Narrative Review. Sports Med 2020; 49:1651-1669. [PMID: 31452130 DOI: 10.1007/s40279-019-01165-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Since the 1960s there has been an escalation in the purposeful utilization of altitude to enhance endurance athletic performance. This has been mirrored by a parallel intensification in research pursuits to elucidate hypoxia-induced adaptive mechanisms and substantiate optimal altitude protocols (e.g., hypoxic dose, duration, timing, and confounding factors such as training load periodization, health status, individual response, and nutritional considerations). The majority of the research and the field-based rationale for altitude has focused on hematological outcomes, where hypoxia causes an increased erythropoietic response resulting in augmented hemoglobin mass. Hypoxia-induced non-hematological adaptations, such as mitochondrial gene expression and enhanced muscle buffering capacity may also impact athletic performance, but research in elite endurance athletes is limited. However, despite significant scientific progress in our understanding of hypobaric hypoxia (natural altitude) and normobaric hypoxia (simulated altitude), elite endurance athletes and coaches still tend to be trailblazers at the coal face of cutting-edge altitude application to optimize individual performance, and they already implement novel altitude training interventions and progressive periodization and monitoring approaches. Published and field-based data strongly suggest that altitude training in elite endurance athletes should follow a long- and short-term periodized approach, integrating exercise training and recovery manipulation, performance peaking, adaptation monitoring, nutritional approaches, and the use of normobaric hypoxia in conjunction with terrestrial altitude. Future research should focus on the long-term effects of accumulated altitude training through repeated exposures, the interactions between altitude and other components of a periodized approach to elite athletic preparation, and the time course of non-hematological hypoxic adaptation and de-adaptation, and the potential differences in exercise-induced altitude adaptations between different modes of exercise.
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Affiliation(s)
- Iñigo Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain. .,Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
| | - Avish P Sharma
- Griffith Sports Physiology and Performance, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Triathlon Australia, Burleigh Heads, QLD, Australia
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Victoria, BC, Canada.,Department of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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5
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Burtscher J, Gatterer H, Burtscher M. Is it time to revise the acclimatization schedule at high altitude? Med J Armed Forces India 2020; 76:120-121. [PMID: 32020982 DOI: 10.1016/j.mjafi.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Johannes Burtscher
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Austria.,Austrian Society for Alpine and Mountain Medicine, Austria
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Kenefick RW, Beidleman BA, Andrew SP, Cadarette BS, Muza SR, Fulco CS. Two-Day Residence at 2500 m to 4300 m Does Not Affect Subsequent Exercise Performance at 4300 m. Med Sci Sports Exerc 2018; 51:744-750. [PMID: 30439786 DOI: 10.1249/mss.0000000000001843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the efficacy residing for 2 d at various altitudes while sedentary (S) or active (A; ~90 min hiking 2 d) on exercise performance at 4300 m. METHODS Sea-level (SL) resident men (n = 45) and women (n = 21) (mean ± SD; 23 ± 5 yr; 173 ± 9 cm; 73 ± 12 kg; V˙O2peak = 49 ± 7 mL·kg·min) were randomly assigned to a residence group and, S or A within each group: 2500 m (n = 11S, 8A), 3000 m (n = 6S, 12A), 3500 m (n = 6S, 8A), or 4300 m (n = 7S, 8A). Exercise assessments occurred at SL and 4300 m after 2-d residence and consisted of 20 min of steady-state (SS) treadmill walking (45% ± 3% SL V˙O2peak) and a 5-mile, self-paced running time trial (TT). Arterial oxygen saturation (SpO2) and HR were recorded throughout exercise. Resting SpO2 was recorded at SL, at 4 and 46 h of residence, and at 4300 m before exercise assessment. To determine if 2-d altitude residence improved 4300 m TT performance, results were compared with estimated performances using a validated prediction model. RESULTS For all groups, resting SpO2 was reduced (P < 0.01) after 4 h of residence relative to SL inversely to the elevation and did not improve after 46 h. Resting SpO2 (~83%) did not differ among groups at 4300 m. Although SL and 4300 m SS exercise SpO2 (97% ± 2% to 74% ± 4%), HR (123 ± 10 bpm to 140 ± 12 bpm) and TT duration (51 ± 9 to 73 ± 16 min) were different (P < 0.01), responses at 4300 m were similar among all groups, as was actual and predicted 4300 m TT performances (74 ± 12 min). CONCLUSIONS Residing for 2 d at 2500 to 4300 m, with or without daily activity, did not improve resting SpO2, SS exercise responses, or TT performance at 4300 m.
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Affiliation(s)
- Robert W Kenefick
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
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An Integrated, Multifactorial Approach to Periodization for Optimal Performance in Individual and Team Sports. Int J Sports Physiol Perform 2018; 13:538-561. [PMID: 29848161 DOI: 10.1123/ijspp.2018-0093] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sports periodization has traditionally focused on the exercise aspect of athletic preparation, while neglecting the integration of other elements that can impact an athlete's readiness for peak competition performances. Integrated periodization allows the coordinated inclusion of multiple training components best suited for a given training phase into an athlete's program. The aim of this article is to review the available evidence underpinning integrated periodization, focusing on exercise training, recovery, nutrition, psychological skills, and skill acquisition as key factors by which athletic preparation can be periodized. The periodization of heat and altitude adaptation, body composition, and physical therapy is also considered. Despite recent criticism, various methods of exercise training periodization can contribute to performance enhancement in a variety of elite individual and team sports, such as soccer. In the latter, both physical and strategic periodization are useful tools for managing the heavy travel schedule, fatigue, and injuries that occur throughout a competitive season. Recovery interventions should be periodized (ie, withheld or emphasized) to influence acute and chronic training adaptation and performance. Nutrient intake and timing in relation to exercise and as part of the periodization of an athlete's training and competition calendar can also promote physiological adaptations and performance capacity. Psychological skills are a central component of athletic performance, and their periodization should cater to each athlete's individual needs and the needs of the team. Skill acquisition can also be integrated into an athlete's periodized training program to make a significant contribution to competition performance.
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Bernardi E, Pomidori L, Cavallari D, Mandolesi G, Cogo A. Residence at Moderate Versus Low Altitude Is Effective at Maintaining Higher Oxygen Saturation During Exercise and Reducing Acute Mountain Sickness Following Fast Ascent to 4559 m. Wilderness Environ Med 2017; 28:122-126. [DOI: 10.1016/j.wem.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
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Abstract
This study aims to evaluate the effect of the duration of high-altitude (HA) pre-exposure on human neurobehavioral parameters including mood states and cognitive performance at HA. One hundred and eleven healthy individuals (ranging in age from 18 to 35 years) were recruited to participate in this study. They were divided into two groups: a 4-day short-term HA pre-exposure group (n=57) and a 3-month long-term HA pre-exposure group (n=54). All participants lived in the area at 400 m altitude above sea level before pre-exposure to HA. They were then transported to 3700 m plateau for either a 4-day or a 3-month HA pre-exposure, and finally delivered to 4400 m plateau. On the last day of pre-exposure at 3700 m and on the 10th day at 4400 m, neurobehavioral parameters of the participants in the two groups were evaluated. At the end of pre-exposure and on the 10th day of HA exposure, participants in the short-term group had significantly lower negative mood states, better cognitive performance with higher sensorimotor, attention, and psychomotor abilities, and less acute mountain sickness in comparison with the participants in the long-term pre-exposure group. Our field study with large samples showed that in comparison with 3-month long-term pre-exposure, 4-day short-term HA pre-exposure at 3700 m has a better effect in improving human neurobehavioral parameters including mood states and cognitive performance and reducing acute mountain sickness when exposed to a HA at 4400 m.
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Chapman RF, Karlsen T, Ge RL, Stray-Gundersen J, Levine BD. Living altitude influences endurance exercise performance change over time at altitude. J Appl Physiol (1985) 2016; 120:1151-8. [DOI: 10.1152/japplphysiol.00909.2015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/04/2016] [Indexed: 11/22/2022] Open
Abstract
For sea level based endurance athletes who compete at low and moderate altitudes, adequate time for acclimatization to altitude can mitigate performance declines. We asked whether it is better for the acclimatizing athlete to live at the specific altitude of competition or at a higher altitude, perhaps for an increased rate of physiological adaptation. After 4 wk of supervised sea level training and testing, 48 collegiate distance runners (32 men, 16 women) were randomly assigned to one of four living altitudes (1,780, 2,085, 2,454, or 2,800 m) where they resided for 4 wk. Daily training for all subjects was completed at a common altitude from 1,250 to 3,000 m. Subjects completed 3,000-m performance trials on the track at sea level, 28 and 6 days before departure, and at 1,780 m on days 5, 12, 19, and 26 of the altitude camp. Groups living at 2,454 and 2,800 m had a significantly larger slowing of performance vs. the 1,780-m group on day 5 at altitude. The 1,780-m group showed no significant change in performance across the 26 days at altitude, while the groups living at 2,085, 2,454, and 2,800 m showed improvements in performance from day 5 to day 19 at altitude but no further improvement at day 26. The data suggest that an endurance athlete competing acutely at 1,780 m should live at the altitude of the competition and not higher. Living ∼300-1,000 m higher than the competition altitude, acute altitude performance may be significantly worse and may require up to 19 days of acclimatization to minimize performance decrements.
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Affiliation(s)
| | - Trine Karlsen
- K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norweigan University of Science and Technology, Trondheim, Norway
| | - R.-L. Ge
- Research Center for High Altitude Medicine, Qinghai University, Qinghai, China
| | | | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, The University of Texas Southwestern Medical Center, Dallas, Texas
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11
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He L, Jiang Y, Su H, Li J, Cheng X. Vascular Endothelial Function Assessed by Postischemic Diastolic Blood Pressure Is Associated with Acclimatization and Acute Mountain Sickness. High Alt Med Biol 2016; 17:11-5. [PMID: 26977539 DOI: 10.1089/ham.2015.0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study assessed whether the brachial diastolic blood pressure (DBP) decline induced by 5-minute arm ischemia is associated with acclimatization and acute mountain sickness (AMS). METHODS Forty-two age- and body mass index-matched young male residents at sea level (<400 m) or moderate altitude (1000-2000 m above sea level) were enrolled. All subjects had never been to 3200 m before. Brachial BP was measured at a station at 1380 m altitude before and 1, 5, and 10 minutes after right arm ischemia. AMS score was evaluated after 3-day training at a high altitude of 3200 m. RESULTS In moderate altitude versus sea-level residents: (1) systolic BP curves for both arms overlapped well; (2) mean right arm DBP decline post right arm ischemia was larger, while left arm, which was not subjected to ischemia, did not show DBP decline in either group; and (3) AMS scores were significantly lower (3.19 ± 2.16 vs. 5.52 ± 4.58, p = 0.043) in those residing at moderate altitude compared to those from low altitude. There was a low negative correlation between AMS score and right arm area between curves-DBP (r = -0.320, p = 0.039). CONCLUSION Moderate altitude relative to sea-level residents had a larger mean postischemic DBP decline in weak but significant association with lower mean AMS score at 3200 m. These data suggest that differences in vascular endothelial function related to altitude of residence persist during travel to high altitude and might contribute to AMS risk.
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Affiliation(s)
- Lipeng He
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Yu Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Hai Su
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Juxiang Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
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The effect of adding CO2 to hypoxic inspired gas on cerebral blood flow velocity and breathing during incremental exercise. PLoS One 2013; 8:e81130. [PMID: 24278389 PMCID: PMC3836745 DOI: 10.1371/journal.pone.0081130] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
Hypoxia increases the ventilatory response to exercise, which leads to hyperventilation-induced hypocapnia and subsequent reduction in cerebral blood flow (CBF). We studied the effects of adding CO2 to a hypoxic inspired gas on CBF during heavy exercise in an altitude naïve population. We hypothesized that augmented inspired CO2 and hypoxia would exert synergistic effects on increasing CBF during exercise, which would improve exercise capacity compared to hypocapnic hypoxia. We also examined the responsiveness of CO2 and O2 chemoreception on the regulation ventilation (E) during incremental exercise. We measured middle cerebral artery velocity (MCAv; index of CBF), E, end-tidal PCO2, respiratory compensation threshold (RC) and ventilatory response to exercise (E slope) in ten healthy men during incremental cycling to exhaustion in normoxia and hypoxia (FIO2 = 0.10) with and without augmenting the fraction of inspired CO2 (FICO2). During exercise in normoxia, augmenting FICO2 elevated MCAv throughout exercise and lowered both RC onset andE slope below RC (P<0.05). In hypoxia, MCAv and E slope below RC during exercise were elevated, while the onset of RC occurred at lower exercise intensity (P<0.05). Augmenting FICO2 in hypoxia increased E at RC (P<0.05) but no difference was observed in RC onset, MCAv, or E slope below RC (P>0.05). The E slope above RC was unchanged with either hypoxia or augmented FICO2 (P>0.05). We found augmenting FICO2 increased CBF during sub-maximal exercise in normoxia, but not in hypoxia, indicating that the ‘normal’ cerebrovascular response to hypercapnia is blunted during exercise in hypoxia, possibly due to an exhaustion of cerebral vasodilatory reserve. This finding may explain the lack of improvement of exercise capacity in hypoxia with augmented CO2. Our data further indicate that, during exercise below RC, chemoreception is responsive, while above RC the ventilatory response to CO2 is blunted.
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